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General NPI Number Information
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NPI Number | 1124641006
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Entity Type | Individual
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Provider Name | JESSICA ANNE BAELE PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 1700 NW 167TH PL STE 245
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City | BEAVERTON
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State | OR
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Zip | 97006-8110
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Country | US
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Telephone | 800-834-6362
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Fax |
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Provider Business Mailing Address
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Address Line | 16489 FREDERICK ST
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City | OREGON CITY
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State | OR
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Zip | 97045-1190
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Country | US
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Telephone | 503-756-6430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA213374
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License Number State | OR
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